Healthcare Provider Details

I. General information

NPI: 1205470960
Provider Name (Legal Business Name): KYLIE E MCCOLLOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 KING GEORGE BLVD
SAVANNAH GA
31419-9547
US

IV. Provider business mailing address

PO BOX 253
SKILLMAN NJ
08558-0253
US

V. Phone/Fax

Practice location:
  • Phone: 912-785-9027
  • Fax: 912-525-2890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA001339
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-75523
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: